| NPI | 1447615372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 021471) |
| Additional Taxonomies | 103T00000X Psychologist |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) | |
| 103TP2701X Psychologist, Group Psychotherapy | |
| Enumeration Date | 2015-12-18 |
| Last Update Date | 2015-12-18 |